Maximum Impact

A will to redirect the resources to priority zones can go a long way in resolving health–related issues in urban areas

Nearly 40 per cent of the world population lives in cities. There is a steady migration of people from rural to urban areas, more so in the developing countries.

This is because of the perceived notion that cities provide greater employment opportunities and thus greater earnings and greater access to education, healthcare and cultural activities. This may not necessarily be true. In addition there are limited opportunities for diversification of careers in rural areas especially in poorer countries.

However, rapid and unplanned urban growth associated with migration is often linked with poverty, environmental degradation and population demands that often outstrip service capacity.

There are a number of urban health hazards such as substandard housing and overcrowding, inadequate sanitation and solid waste disposal, increased vehicular traffic and stress associated with unemployment. This leads on to increased incidence of smoking, alcohol and substance abuse and higher crime rates especially against the vulnerable groups of children, women and the elderly.

Knowing the health hazards, many of the solutions are obvious, but may be difficult to implement due to financial and political reasons. Improved urban living conditions including low cost group housing and removal of slums along with creation of open spaces for physical activities are important steps.

Provision of clean drinking water, removal and proper disposal of garbage and sewage is likely to resolve a major chunk of health–related issues. Many such actions do not require additional funding, but a will to redirect the resources to priority areas.

Greater accountability on the part of governmental organisations can ensure implementation of several of these issues with existing resources.

There exists a need to provide graded healthcare facilities in different areas of cities wherein all sections of society can have access to basic healthcare. Some of these are improved immunisation services, attention to nutrition in children of the underprivileged sections, universal access to basic education and creation of a support system of the elderly.

A private–public partnership can create a fund to offer career opportunities to bright children whose parents cannot afford to send them for higher education, because one such success can truly lift a large number of persons in their immediate family.

Civic authorities also need to provide proper zoning so that residential and industrial areas can be kept apart. Good urban planning and governance, exchange of ideas between civic authorities of different cities for copying successful models, determination to overcome challenges and committed involvement of leadership across disciplines, sectors, communities and countries will be critical elements of success.

(Dr Trehan is a renowned cardio–vascular surgeon and CMD of Medanta – The Medicity a multi–super speciality institute)

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